Background and objective Although the relationships between BMI and cardiac geometry and function have been established, information remains limited on the impact of BMI, waist circumference and body composition variations over time on echocardiographic changes in ageing adults. Methods and results Multiple linear regressions were used to correlate cardiac echographic parameters and baseline anthropometric data and their changes over 6 years in 280 participants of the SU.VI.MAX 2 cohort study. During the follow-up, BMI increased by 0.6 (95% confidence interval: 0.3-0.8) kg/m(2), waist circumference by 2.3 (1.6-3.0) cm and percentage body fat mass (%BFM) by 4.0 (3.4-4.6) %. A 6-year change (2001-2007) by 1 kg/m(2) in BMI or 1 cm in waist circumference was associated with an increase in indexed left ventricular mass by 2.3 g/m(2.7) (1.3-3.3, P < 0.001) and 0.4 g/m(2.7) (0.06-0.6, P < 0.017), respectively, and an increase in left atrial area by 0.3 cm(2) (0.1-0.5, P < 0.001) and 0.05 cm(2) (0.003-0.10, P < 0.037), respectively. Follow-up left ventricular mass and left atrial area were not impacted by changes in percentage body fat mass. A significant correlation was observed between E-wave transmitral flow deceleration time and baseline BMI and waist circumference, but not with their changes over time. Conclusion Changes in anthropometric markers over time are associated with increased left ventricular mass and left atrial size. These findings reinforce the potential benefit of a healthy diet and lifestyle to maintain body weight and, in turn, cardiac geometry and function in ageing adults. J Hypertens 28: 2309-2315 (C) 2010 Wolters Kluwer Health | Lippincott Williams & Wilkins.